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Leale I, Di Stefano V, Costanza C, Brighina F, Roccella M, Palma A, Battaglia G. Telecoaching: a potential new training model for Charcot-Marie-Tooth patients: a systematic review. Front Neurol 2024; 15:1359091. [PMID: 38784904 PMCID: PMC11112069 DOI: 10.3389/fneur.2024.1359091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Charcot-Marie-Tooth disease (CMT) is an inherited neuropathy that affects the sensory and motor nerves. It can be considered the most common neuromuscular disease, with a prevalence of 1/2500. Methods Considering the absence of a specific medical treatment and the benefits shown by physical activity in this population, a systematic review was completed using several search engines (Scopus, PubMed, and Web of Science) to analyze the use, effectiveness, and safety of a training program performed in telecoaching (TC). TC is a new training mode that uses mobile devices and digital technology to ensure remote access to training. Results Of the 382 studies identified, only 7 met the inclusion criteria. The effects of a TC training program included improvements in strength, cardiovascular ability, and functional abilities, as well as gait and fatigue. However, the quality of the studies was moderate, the size of the participants in each study was small, and the outcome measured was partial. Discussion Although many studies have identified statistically significant changes following the administration of the TC training protocol, further studies are needed, with appropriate study power, better quality, and a higher sample size.
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Affiliation(s)
- Ignazio Leale
- Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
- Ph.D. Program in Health Promotion and Cognitive Sciences, University of Palermo, Palermo, Italy
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Carola Costanza
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience, and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonio Palma
- Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Giuseppe Battaglia
- Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
- Regional Sports School of Italian National Olympic Committee (CONI) Sicilia, Palermo, Italy
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Intractable Rare Dis Res 2018; 7:164-171. [PMID: 30181935 PMCID: PMC6119673 DOI: 10.5582/irdr.2018.01060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neuromuscular disorder caused by the mutation of the SACS gene. Clinical symptoms of this disease include progressive ataxia, spasticity, and peripheral neuropathy. Similar to other neuromuscular disorders, these patients are prone to physical deconditioning which may lead to a loss of functional capacity. This paper aims to evaluate the impact of a training program on the physical fitness and the functional capacity of ARSACS patients. Twelve patients (age: 28.1 ± 8.2 years) participated in this study. They followed an eight-week training program including physical activities, strength-power and aerobic training. Compared to the initial evaluation, measures of physical fitness and functional capacity were significantly improved (p ≤ 0.05) for 11 of the 12 tests. Positive gains were also observed for fall frequency and for upper-limb incoordination. This paper supports the importance of a training program for ARSACS patients in order to improve their quality of life. Through these types of interventions, it may be possible to slow down the progression of the disease and help maintain functional capacity.
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Affiliation(s)
- Olivier Audet
- Deparment of Kinesiology, Université Laval, Québec, Canada
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Alain-Steve Comtois
- Department of Exercise Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
- Address correspondence to:Dr. Mario Leone, Department of Health, Kinesiology Division, Université du Québec à Chicoutimi, 555 boulevard de l'Université, Saguenay (Québec), G7H 2B1, Canada. E-mail:
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. WITHDRAWN: Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Biosci Trends 2018. [PMID: 30012892 DOI: 10.5582/bst.2018.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ahead of Print article withdrawn by publisher. This withdrawal is for above article due to the misoperation of advance online publication.
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Affiliation(s)
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi
| | | | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi
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Nakada CS, Meningroni PC, Ferreira ACS, Hata L, Fuzaro AC, Júnior WM, de Araujo JE. Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy. J Exerc Rehabil 2018; 14:503-508. [PMID: 30018940 PMCID: PMC6028200 DOI: 10.12965/jer.1836178.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=−3.52, CS=52%), but not the left TAm (t= −3.35). Flexion-abduction with external rotation pattern to the right (t= −2.46, CS=55%) and left (t=−2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=−0.25) and left (t=−1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.
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Affiliation(s)
- Carolina S Nakada
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Paula C Meningroni
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Ana Claudia Silva Ferreira
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Luciana Hata
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Amanda C Fuzaro
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Wilson Marques Júnior
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
| | - João Eduardo de Araujo
- Laboratory of Neuropsychobiology and Motor Behavior, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (USP), Ribeirão Preto, Brazil
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Effects of Self-Selected Exercise on Strength in Charcot-Marie-Tooth Disease Subtypes. Can J Neurol Sci 2017; 44:572-576. [PMID: 28669366 DOI: 10.1017/cjn.2017.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preliminary studies have supported the utility of exercise as a treatment for Charcot-Marie-Tooth disease (CMT) patients. Despite being the most common inherited neuropathy, there remains a paucity of guidelines for CMT management. METHODS A retrospective chart review was performed on 297 CMT patients. Self-reported exercise and strength results from standardized dynamometer testing were obtained from adult patients' first visits. Values were converted and analyzed based on previously reported age- and sex-matched normative values. RESULTS Participants with CMT2 had greater strength values than those with CMT1 in hand grip, elbow flexion, and dorsiflexion (p<0.05). Participants with CMT1 and CMT2 who exercised were statistically significantly stronger in elbow flexion and dorsiflexion than those who did not exercise. CONCLUSIONS These preliminary results suggest that self-directed exercise is associated with greater strength in CMT patients of both CMT1 and CMT2 subtypes. Self-directed exercise may be a convenient, sustainable, and effective method of improving strength and decreasing disability in this population. Future research should explore the type of exercise prescription that best addresses the needs of the CMT population.
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Impact of habitual exercise on the strength of individuals with myotonic dystrophy type 1. Am J Phys Med Rehabil 2015; 93:739-46; quiz 747-8. [PMID: 24743456 DOI: 10.1097/phm.0000000000000088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It remains unclear whether habitual physical activity can attenuate the rate of progressive muscle strength loss in individuals with myotonic dystrophy type 1 (DM1). The aim of this study was to identify whether there were any strength differences between DM1 patients who were habitually active or sedentary. DESIGN Knee extension, handgrip, and elbow flexion quantitative strength measurements were investigated in the DM1 patients using isokinetic dynamometry. Strength was compared between the patients who followed self-selected formal exercise plans for at least 1 yr, those who were sedentary (controls), and those who initiated or terminated a formal exercise routine. RESULTS Physically active DM1 patients with midrange CTG repeat size (100-500 CTG repeat sizes) had significantly stronger handgrip and knee extension and elbow flexion torques as compared with their sedentary counterparts with the same CTG repeat range. The DM1 patients who began a formal exercise routine experienced a significant improvement in knee extension torque measurements (+24.3%) in comparison with those who were habitually active or sedentary. CONCLUSIONS These data suggest that there is an association between physical activity and strength. This may be shown to be a useful tool for the management of this condition. Further investigations into the relationships between physical exercise, muscle weakness, and genetic factors are needed before evidence-based recommendations can be made.
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Menotti F, Laudani L, Damiani A, Mignogna T, Macaluso A. An anterior ankle-foot orthosis improves walking economy in Charcot-Marie-Tooth type 1A patients. Prosthet Orthot Int 2014; 38:387-92. [PMID: 24100074 DOI: 10.1177/0309364613506250] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot orthoses are commonly prescribed in Charcot-Marie-Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop. OBJECTIVES This study aimed at assessing the effect of an anterior ankle-foot orthosis on walking economy in a group of Charcot-Marie-Tooth type 1A patients. STUDY DESIGN Within-group comparisons. METHODS 7 Charcot-Marie-Tooth type 1A patients (four women and three men; 37 ± 11 years; age range = 22-53 years) were asked to walk on a circuit at their self-selected speeds ('slow', 'comfortable' and 'fast') in two walking conditions: (1) with shoes only and (2) with Taloelast(®) anterior elastic ankle-foot orthoses. Speed of walking and metabolic cost of walking energy cost per unit of distance were assessed at the three self-selected speeds of walking for both walking conditions. RESULTS Speed of walking at the three self-selected speeds did not differ between shoes only and anterior elastic ankle-foot orthoses, whereas walking energy cost per unit of distance at comfortable speed was lower in patients using anterior elastic ankle-foot orthoses with respect to shoes only (2.39 ± 0.22 vs 2.70 ± 0.19 J kg(-1) m(-1); P < 0.05). CONCLUSIONS In Charcot-Marie-Tooth type 1A patients, the use of anterior elastic ankle-foot orthoses improved walking economy by reducing the energy cost of walking per unit of distance, thus reflecting a lower level of metabolic effort and improved mechanical efficiency in comparison with shoes only. CLINICAL RELEVANCE From a practical perspective, Charcot-Marie-Tooth type 1A patients with anterior elastic ankle-foot orthoses can walk for a longer duration with a lower level of physical effort. Improvements in walking economy due to ankle-foot orthoses are likely a consequence of the reduction in steppage gait.
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Affiliation(s)
- Federica Menotti
- Department of Human Movement, Social and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - Luca Laudani
- Department of Human Movement, Social and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - Antonello Damiani
- Unione Italiana Lotta alla Distrofia Muscolare (UILDM), Sezione Laziale, Rome, Italy
| | | | - Andrea Macaluso
- Department of Human Movement, Social and Health Sciences, University of Rome Foro Italico, Rome, Italy
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Abstract
In this review, we present an overview of the role of exercise in neuromuscular disease (NMD). We demonstrate that despite the different pathologies in NMDs, exercise is beneficial, whether aerobic/endurance or strength/resistive training, and we explore whether this benefit has a similar mechanism to that of healthy subjects. We discuss further areas for study, incorporating imaginative and novel approaches to training and its assessment in NMD. We conclude by suggesting ways to improve future trials by avoiding previous methodological flaws and drawbacks in this field.
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Affiliation(s)
- Yaacov Anziska
- Department of Neurology, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, New York, 11203, USA.
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Abstract
Amyotrophic lateral sclerosis (ALS), the most common adult motor neuron disease, is an acquired disorder that results in loss of function in multiple domains. Although there is no treatment that can halt or reverse this progressive condition, there are many opportunities for interventions that can lead to improved quality of life for the patient and caregiver. Physical and occupational therapy can assist with mobility and activities of daily living. Interventions by speech pathology can optimize nutrition and communication. Respiratory function can be managed noninvasively or invasively. Depression, hopelessness, anxiety, and other mental health issues can and should be aggressively addressed and treated. Many symptoms such as pseudobulbar affect, sialorrhea, constipation, spasticity, and cramps can be treated effectively with medications. Spirituality and religion are important issues to address, as are end-of-life concerns, including advance directives, hospice, and the dying process. In contrast to the discouraging view that "there is nothing we can do," a broad approach to management, through collaboration with a multidisciplinary team, will permit the ALS physician to make a meaningful difference in the lives of individuals living with ALS.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neurodegenerative disease in which much burden is geared towards end-of-life care. Particularly in the earlier stages of ALS, many people have found both physiological and psychological boosts from various types of physical exercise for disused muscles. Proper exercise is important for preventing atrophy of muscles from disuse-a key for remaining mobile for as long as possible-and as long as it is possible to exercise comfortably and safely, for preserving cardiovascular fitness. However, the typical neuromuscular patient features a great physical inactivity and disuse weakness, and for that reason many controversial authors have contested exercise in these patients during years, especially in ALS which is rapidly progressive. There is an urgent need for dissecting in detail the real risks or benefits of exercise in controlled clinical trials to demystify this ancient paradigm. Yet, recent research studies document significant benefits in terms of survival and quality of life in ALS, poor cooperation, small sample size, uncontrolled and short-duration trials, remain the main handicaps. Sedentary barriers such as early fatigue and inherent muscle misuse should be overcome, for instance with body-weight supporting systems or non-invasive ventilation, and exercise should be faced as a potential non-monotonous way for contributing to better health-related quality of life.
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Hartley SE, Goodwin PC, Goldbart J. Experiences of attendance at a neuromuscular centre: perceptions of adults with neuromuscular disorders. Disabil Rehabil 2011; 33:1022-32. [DOI: 10.3109/09638288.2010.520812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Menotti F, Felici F, Damiani A, Mangiola F, Vannicelli R, Macaluso A. Charcot-Marie-Tooth 1A patients with low level of impairment have a higher energy cost of walking than healthy individuals. Neuromuscul Disord 2010; 21:52-7. [PMID: 21074996 DOI: 10.1016/j.nmd.2010.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
The study aimed at quantifying the walking energy cost of a group of Charcot-Marie-Tooth 1A patients (CMT1A), with low severity of walking impairment, in comparison with healthy individuals. Oxygen uptake was measured in 8 patients (age-range 20-48 years; Barthel >90; Tinetti >20) and 8 healthy individuals, matched for age and gender, when walking on a circuit for 5-min at their self-selected speeds ("slow", "comfortable" and "fast"). Both comfortable and fast speeds were lower in patients than in the control group (0.92±0.16 vs 1.16±0.22 and 1.27±0.27 vs 1.61±0.22 m s⁻¹, respectively; P<0.05), whereas walking energy cost per unit of distance was higher in patients than in the control group (P<0.05) at both "comfortable" (2.27±0.35 vs 1.92±0.21 J kg⁻¹m⁻¹) and "fast" speed (3.05±0.35 vs 2.37±0.42 J kg⁻¹m⁻¹). CMT1A patients, therefore, choose to walk slower but with higher metabolic cost compared to healthy individuals, despite no clinically evident walking impairment, which is likely due to altered walking patterns.
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Affiliation(s)
- Federica Menotti
- Department of Human Movement and Sport Sciences, University of Rome Foro Italico, Rome, Italy
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Abstract
Major advances in the fields of medical science and physiology, molecular genetics, biomedical engineering, and computer science have provided individuals with muscular dystrophy (MD) with more functional equipment, allowing better strategies for improvement of quality of life. These advances have also allowed a significant number of these patients to live much longer. As progress continues to change management, it also changes patients' expectations. A comprehensive medical and rehabilitative approach to management of aging MD patients can often fulfill expectations and help them enjoy an enhanced quality of life.
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Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee consistently demonstrates a knowledge of the pathophysiology of various specific impairments including lower motor neuron weakness’ and ‘management approaches for specific impairments including lower motor neuron weakness’. This article explores weakness as a lower motor symptom. Weakness as a primary impairment of neuromuscular diseases is addressed, with recognition of the phenomenon of disuse atrophy, and how weakness impacts on the functional abilities of people with myopathy and neuropathy. Interventions to reduce weakness or address the functional consequences of weakness are evaluated with consideration of safety and clinical application. Learning outcomes: This paper will allow readers to: (1) appraise the contribution of research in rehabilitation of lower motor neuron weakness to clinical decision making and (2) engage with the issues that arise when researching rehabilitation interventions for lower motor neuron weakness. Aim of article: Impairments associated with neuromuscular conditions can lead to significant functional difficulties that can impact on a person’s daily participation. This article focuses on the primary impairment of weakness and explores the research evidence for rehabilitation interventions that directly influence weakness or address the impact of weakness on function.
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Affiliation(s)
- Gita M Ramdharry
- St George's School of Physiotherapy, Faculty of Health and Social Care Sciences, St George's University of London and Kingston University, UK,
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Abstract
For many years, children with cerebral palsy (CP) and their parents have been told that health and functional status stabilize by early adulthood. However, adults with CP report ongoing health conditions and aging and secondary conditions that are not always recognized or managed by their healthcare providers. There is a growing body of literature to better define the health, mortality, and wellness of those aging with CP. In general, adults with CP report good health, although health outcomes appear to be linked to the severity of CP and to increasing age. Studies reporting on lifespan warrant caution in interpretation because of biases in the survey and surveillance systems. It appears that lifespan of persons with CP is at or close to that of the typical population. The most commonly reported age-related changes and secondary conditions involve pain/fatigue, physical performance, and the musculoskeletal system. Not all adults have serious health problems, and many now recognize the aging process as a natural course of events. Few adults with CP engage in typical screening and health promotion activities due to a variety of barriers. There continues to be much to be learned and disseminated, in order to improve the care of adults with CP.
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Affiliation(s)
- Margaret A Turk
- Departmentof Physical Medicine and Rehabilitation and Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA.
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A Systematic Review of the Effect of Moderate Intensity Exercise on Function and Disease Progression in Amyotrophic Lateral Sclerosis. J Neurol Phys Ther 2009; 33:68-87. [DOI: 10.1097/npt.0b013e31819912d0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular Diseases: A Systematic Review. Arch Phys Med Rehabil 2007; 88:1452-64. [DOI: 10.1016/j.apmr.2007.07.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/24/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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Scheets PL, Sahrmann SA, Norton BJ. Use of movement system diagnoses in the management of patients with neuromuscular conditions: a multiple-patient case report. Phys Ther 2007; 87:654-69. [PMID: 17504829 DOI: 10.2522/ptj.20050349] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Medical diagnoses are not sufficient to guide physical therapy intervention. To provide a rational basis for treatment selection by physical therapists, we developed a set of diagnoses at the level of impairment that are relevant to the human movement system. The diagnoses describe the primary human movement system problem and provide a basis for matching a specific problem with appropriate treatment. The purposes of this 3-patient case report are to illustrate an updated version of the diagnostic system and to show how treatment decisions can be made relative to both the movement system diagnosis and the patient's prognosis. CASE DESCRIPTION AND OUTCOMES We diagnosed 3 patients with hemiplegia due to stroke as having 3 different movement system problems: force production deficit, fractionated movement deficit, and perceptual deficit. Specific intervention and actual patient outcomes for each case are outlined. DISCUSSION Use of movement system diagnoses may have multiple benefits for patient care. The possible benefits include decreasing the variability in management of patients with neuromuscular conditions, minimizing the trial-and-error approach to treatment selection, improving communication among health care professionals, and advancing research by enabling creation of homogenous patient groupings.
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Affiliation(s)
- Patricia L Scheets
- Therapy Services, Department of Rehabilitation, Carle Foundation Hospital, Urbana, IL 61801, USA.
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Abstract
The primary purpose of this study was to examine the effects of an exercise program on physical fitness, psychosocial factors, and symptoms in two men with fibromyalgia syndrome (FMS). An interventional case study research design was used to collect data on physical fitness, psychosocial factors, and symptoms at intervals throughout a 14-month period. Raw scores and raw score averages, devoid of statistical manipulation, are presented to display real individual results. The secondary purpose of the study was to discuss how these two men tolerated the program in comparison to women in a similar program. This is important because data on men with FMS appear to be unavailable, because the greater majority of participants in FMS programs are women. Results support that these two men benefited from the program and that differences between men and women with FMS should be considered relative to the conduct of exercise programs for these groups.
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Affiliation(s)
- William B. Karper
- Department of Exercise and Sport Science, School of Health and Human Performance, University of North Carolina at Greensboro, wbkarper@ uncg.edu
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Smith CA, Chetlin RD, Gutmann L, Yeater RA, Alway SE. Effects of exercise and creatine on myosin heavy chain isoform composition in patients with Charcot-Marie-Tooth disease. Muscle Nerve 2006; 34:586-94. [PMID: 16881064 DOI: 10.1002/mus.20621] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is not known whether myosin heavy chain (MHC) content changes in response to exercise training or creatine supplementation in subjects with Charcot-Marie-Tooth disease (CMT). Based on previous data, we hypothesized that resistance exercise and creatine would increase the percentage of type I MHC composition in the vastus lateralis muscle and that myosin isoform changes would correlate with improved chair rise-time in CMT subjects. To test this hypothesis, 18 CMT subjects were randomly assigned to either a placebo or creatine group. All subjects performed a 12-week, home-based, moderate-intensity resistance training program. Chair rise-time was measured before and after the training program. Muscle biopsies were obtained from the vastus lateralis before and after the 12-week program. Gel electrophoresis showed a significant decrease (approximately 30%) in MHC type I in CMT subjects given creatine supplementation when compared with placebo. There was a nonsignificant increase in both MHC type IIa (approximately 23%) and MHC type IIx (approximately 7%) in CMT subjects given creatine. Reduced MHC type I content and increased MHC type IIa content correlated with faster chair rise-times (i.e., improved muscle performance). The training-induced change in MHC IIa content was inversely correlated with chair rise-time in CMT subjects given creatine. When the two subject groups were combined, there was a linear, negative relationship between the change in MHC type IIa content and chair rise-time after training and a positive relationship between the training-induced change in MHC type I content and chair rise-time. These data suggest that improved function (chair rise-time) was associated with a lower level of MHC type I and increased MHC type IIa composition. Furthermore, the data are consistent with the hypothesis that creatine supplementation alters MHC composition in CMT patients undergoing resistance training and that MHC changes associated with creatine supplementation can improve muscle function.
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Affiliation(s)
- Cheryl A Smith
- Laboratory of Muscle Biology and Sarcopenia, Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
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Exercise role in neuromuscular disorders: A brief review and future directions. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006. [DOI: 10.1016/s0873-2159(15)30465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Simmons Z. Management strategies for patients with amyotrophic lateral sclerosis from diagnosis through death. Neurologist 2005; 11:257-70. [PMID: 16148733 DOI: 10.1097/01.nrl.0000178758.30374.34] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disorder that is inevitably fatal. There are no effective treatments to stop or reverse the natural course of the disease. The role of the physician is to provide comfort and optimize quality of life. REVIEW SUMMARY Management of patients with ALS is a process extending over months to years. It begins with breaking the news of the diagnosis and extends through the terminal phase. Medication may extend lifespan by a small amount. However, most efforts are centered around symptom management. Areas of importance include respiration, nutrition, secretions, communication, pseudobulbar affect, therapy and exercise, spasticity and cramps, pain, depression and suicide, spirituality and religion, cognitive changes, the development of advance directives, and care at the end of life. Multidisciplinary ALS clinics provide much-needed support for patients with ALS and their caregivers. CONCLUSION Although physicians cannot cure ALS or even halt progression, there is much that can be done to manage the physical and emotional symptoms, thereby maintaining or enhancing quality of life.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Penn State College of Medicine, Hershey, 17033, USA.
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Hoffman AJ, Jensen MP, Abresch RT, Carter GT. Chronic Pain in Persons with Neuromuscular Disease. Phys Med Rehabil Clin N Am 2005; 16:1099-112, xii. [PMID: 16214063 DOI: 10.1016/j.pmr.2005.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Amy J Hoffman
- Department of Rehabilitation Medicine, Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA
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Abstract
The relationship between physical functioning and physical activity isa reciprocal one; physical functioning provides the individual with the capability to engage in physical activities, and physical activity helps to maintain and in some cases improve physical functioning. This reciprocal relationship, coupled with the high prevalence of physical inactivity among persons aging with a disability, has profound implications for rehabilitation practice, especially in evaluating intermediate and long-term outcomes of clinical practice. For rehabilitation to play a role in the long-term maintenance and enhancement of physical functioning among persons with disabilities, increasing participation in various types of physical activity in the community must be part of the recovery and maintenance continuum. There is also a critical need to identify specific doses of physical activity for specific disabilities and secondary conditions. HMOs and other health insurers will require evidence-based outcomes before establishing reimbursement procedures for physical activity programs for persons aging with a physical disability.
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Affiliation(s)
- James H Rimmer
- Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Rd., Chicago, IL 60608-6904, USA.
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Haley SM, Fragala-Pinkham M, Latham NK, Skrinar AM, Cogswell D. The emerging role of the pediatric physical therapist in evaluation and intervention for individuals with lysosomal storage diseases. Pediatr Phys Ther 2005; 17:128-39. [PMID: 16357663 DOI: 10.1097/01.pep.0000163077.26274.9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this article are to describe the pathology, medical implications, and typical impairments of individuals with various lysosomal storage diseases (LSDs), summarize results of recent clinical trials on medical interventions relevant to physical therapy practice, report new advances in functional measurement, and suggest a framework for physical therapy management and intervention. SUMMARY OF KEY POINTS Medical and surgical interventions are enabling individuals with LSDs to not only survive but to improve their daily functioning and quality of life. This is likely to become an increasing area of emphasis in pediatric physical therapy, as the intervention emphasis for some individuals will shift from maintenance to restorative programs. RECOMMENDATIONS We recommend that pediatric physical therapists become familiar with new LSD therapeutics, play a major role in evaluating impairment and functional limitation changes in individuals with LSDs, and become knowledgeable about the indications and precautions for restorative physical therapy programs.
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Affiliation(s)
- Stephen M Haley
- Department of Rehabilitation Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215-1605, USA.
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Chetlin RD, Gutmann L, Tarnopolsky M, Ullrich IH, Yeater RA. Resistance training effectiveness in patients with Charcot-Marie-Tooth disease: recommendations for exercise prescription. Arch Phys Med Rehabil 2004; 85:1217-23. [PMID: 15295743 DOI: 10.1016/j.apmr.2003.12.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the effects of a 12-week, home-based resistance exercise program on strength, body composition, and activities of daily living (ADLs) in men and women with Charcot-Marie-Tooth (CMT) disease and to design an ADL-based resistance exercise prescription template. DESIGN Double-blind, placebo-controlled study. SETTING Testing in a university setting; exercise in patients' homes. PARTICIPANTS Twenty CMT patients who volunteered. INTERVENTION Subjects progressively strength trained at home 3 d/wk for 12 weeks. MAIN OUTCOME MEASURES Timed ADLs, isometric strength, and body composition. RESULTS Absolute strength was greater in men with CMT in only 4 of 10 baseline measures (P<.05), but not when strength was normalized by lean mass. Training compliance was 87% with no gender differences. At baseline, women had 80% of normal strength in 4 of 10 measures, whereas men did not achieve 80% of normal strength in any measure. After training, women had 80% of normal strength in 8 of 10 measures, whereas men only had 80% of normal strength in 1. Training volumes and strength change scores showed no gender differences. ADLs improved after training with no gender differences (P<.05). An exercise prescription template was developed by using chair-rise time to estimate starting weights for lower body and supine rise for upper body. CONCLUSIONS Resistance training improved strength and ADLs equally in men and women. We designed an exercise prescription recommendation, based on ADL performance.
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Affiliation(s)
- Robert D Chetlin
- Department of Human Performance & Applied Exercise Science, School of Medicine, West Virginia University, Morgantown, WV 26506-9139, USA.
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29
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Chetlin RD, Gutmann L, Tarnopolsky MA, Ullrich IH, Yeater RA. Resistance training exercise and creatine in patients with Charcot-Marie-Tooth disease. Muscle Nerve 2004; 30:69-76. [PMID: 15221881 DOI: 10.1002/mus.20078] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Resistance exercise and creatine supplementation independently improve strength and function in patients with certain neuromuscular diseases. The purpose of this study was to examine the effects of resistance training with and without creatine supplementation on muscle, strength, and function in patients with Charcot-Marie-Tooth (CMT) disease. Twenty patients with CMT consumed 5 g/day creatine or placebo while participating in resistance training for 12 weeks. Energy metabolites, muscle fiber type and size, strength, and timed activities of daily living were measured before and after training. There were no differences between creatine or placebo groups for any outcome. For the groups combined, exercise training increased type I muscle fiber diameter (48.2 +/- 14.2 microm vs. 55.4 +/- 14.8 microm), strength, and activities of daily living (ADL) times. Thus, patients respond to resistance training with muscle fiber adaptations, and improvements in strength and function. Creatine was not beneficial.
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Affiliation(s)
- Robert D Chetlin
- Department of Human Performance and Applied Exercise Science, West Virginia University, P.O. Box 9139, Morgantown, West Virginia 26506-9139, USA.
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Karper WB, Stasik SC. A successful, long-term exercise program for women with fibromyalgia syndrome and chronic fatigue and immune dysfunction syndrome. CLIN NURSE SPEC 2003; 17:243-8. [PMID: 14501305 DOI: 10.1097/00002800-200309000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes an ongoing, long-term clinical exercise program for women with fibromyalgia syndrome (FMS), some of whom also have chronic fatigue and immune dysfunction syndrome (CFIDS). The recorded outcomes from the most recent year of the program also are reported. Participants engaged in sessions lasting 50-70 minutes, 5 days per week; each session involved aerobic activity, resistance training, and other dynamic exercise. One group was in the program for 3 years and another group was in the program for 2 years. Program outcomes for the year (comparing beginning and end-of-year results) are presented for both groups on physical fitness, psychosocial, and FMS/CFIDS symptoms. The outcomes support that all of the women appear to have benefited from the program in numerous ways, suggesting that the program works. Also, those outcomes are in agreement with past research reported in this journal. Implications for clinical nurse specialists working with FMS/CFIDS patients are discussed.
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Affiliation(s)
- William B Karper
- University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402, USA.
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Abstract
In the past, patients with neuromuscular diseases were advised not to exercise because of the fear that too much exercise might produce "overuse weakness." No controlled studies have demonstrated that the phenomenon of overuse weakness actually exists. Most studies of exercise training in patients with neuromuscular disease, despite methodologic limitations, suggest that strength and aerobic capacity gains can occur in patients with slowly progressive disorders. Four forms of exercise training are relevant to patients with neuromuscular disorders: flexibility, strengthening, aerobic, and balance exercises. The literature regarding these forms of exercise in patients with neuromuscular disorders is summarized in this article, and recommendations are made regarding the direction future research on exercise in this population should take.
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Affiliation(s)
- Lisa S Krivickas
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School Director, Electrodiagnostic Services, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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